‘First, do no harm” is the sacrosanct principle that is supposed to underpin modern medicine. But history is littered with examples of medics breaching this doctrine. Last week, the publication of Hilary Cass’s final report on healthcare for gender-questioning children laid bare the devastating scale of NHS failures of a vulnerable group of children and young people, buoyed by adult activists bullying anyone who dared question a treatment model so clearly based on ideology rather than evidence.

Cass is a renowned paediatrician and her painstakingly thorough review was four years in the making. She sets out how the now-closed NHS specialist gender clinic for children abandoned evidence-based medicine for a wing and a prayer. Significant numbers of gender-questioning children – it’s impossible to know exactly how many because the clinic did not keep records, itself a scandal – were put on an unevidenced medical pathway of puberty-blocking drugs and/or cross-sex hormones, despite risks of harm in relation to brain development, fertility, bone density, mental health and adult sexual functioning.

What drove this? The medical pathway is rooted in a belief that many, perhaps even most children questioning their gender will go on to have a fixed trans identity in adulthood, and that it is possible to discern them from those for whom it is a temporary phase. But studies suggest that gender dysphoria resolves itself naturally in many children. It is often associated with neurodiversity, mental health issues, childhood trauma, discomfort about puberty, particularly in girls, and children processing their emerging same-sex attraction; a large number of children referred to the Gender Identity Development Service (Gids) were gay. Putting these children on a medical pathway does not just come with health risks,........

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